S7E6: Beyond Borders—The Journey of an International Medical Graduate

Hạ: Hello, dear listeners. I am in the virtual studio, but also not virtual studio because we are sharing a mic. And I am so excited to record another episode for "Bundle of Hers." Woohoo. I am also really, really excited to introduce you to, as I alluded to my special guest today, Nina. Nina, do you want to introduce yourself to everyone?

Nina: Sure. So I'm Nina Mercado. I am from Colombia. I was there for the last 30 years. Oh my gosh. I am in the 30s. That's so unbelievable. And I have been in the U.S. for the last four years trying to pursue my dream to be a doctor here.

Hạ: Nina, you look glowing and youthful all the time. So no one would know that you're in the 30s unless you outed yourself, which you just did for all of our listeners.

So as Nina kind of alluded to in her introduction, we're super excited to have her here today because her story is a very awesome story, and we wanted her to be able to share her story. And that's kind of what the topic is about for today. It's just really focusing on Nina and her pathway to medicine.

And the reason why I really wanted you to join Nina is because I feel that a lot of times, especially if you're centered in the U.S. medical system, you're focused on a very typical story of medicine in a very particular pathway that's very focused on U.S. MD allopathic graduates.

And just for our listeners who don't really know the different categories in medicine, in the U.S., you can get a medical degree. Then there are two types of medical degrees that you can pursue if you want to be a physician. One is osteopathic, or DO. One is allopathic, and it's MD. And there are always stigma and biases and controversies about MD versus DO.

All to say is U.S. and the elitist institutional way that our systems work, we tend to like to focus on a very particular narrative. And all of this that I just spoke about right now, I was just talking about even U.S. medical graduates. It gets even more complex when you're a person who's international and wants to practice in the U.S.

I feel that Nina's story is a very important perspective for people to hear. And it really harkens to a lot of what this podcast is about, which is really shining light on perspectives that are not really told or well represented.

Before we really let Nina talk a bit more and really start this conversation, I do want to say that this conversation here today is exclusively ours, and it does not reflect the institutions that we and this podcast are a part of.

Nina, I know this is the most cliche story, but when did you know you wanted to be a doctor?

Nina: Oh my gosh. It was long time ago. Well, in South America, medical school is different. So we usually go from high school directly to the university for med school, and it's six years of school. I'm sorry for repeating that. So we do different years where we have basic, we have clinics, we can enjoy the clinic with taking care of different patients, and we finish with one year of intern. Usually in the U.S., that year is your first year of residency. For us, it's our last year of med school.

It was rare that the beginning of my deciding why I wanted to study medicine, it was crazy. I was just 16 years old. I didn't know what to do with my life. I was like, "Yeah, I want to be powerful woman. I want to go to business. I want to have the world in my hands."

So I was having all these crazy dreams, and my dad was like, "Nah, girl. You are not that." And I was like, "What?" And he was like, "No. Do you have a heart? You are not that type of girl." And I was like, "Never mind."

So I tried to prove myself. I went to the community college in Colombia, so I did a nurse degree. And I was studying there while trying to figure out what to do. And in my mind, I always was like, "Yeah, after that, I can get a job and I can go to the university study whatever I want to do. My dad doesn't know me." That was my thoughts by that time. But during the nursing school, I was taking care of my patients, so I was like, "Oh my gosh, he knows me."

So when I finished the nurse school, I was like, "Yeah, medicine is in my mind. I want to call and try to take care of people that need me." So I went to med school. Difficult to go into the med school because it's a lot of applicants with just a couple of spots.

When I get into the med school, I was like, "Yeah, but I don't want to study there. Everybody is 16, 17. They just want to get out of their family. They just want to know the world." But that was not my case. We didn't have enough economic support, so I have to keep in the same city as my parents. And I had a scholarship, so it was just like everything was perfect to go into the med school. So I was like, "Yeah, that's the time."

So I did my six years. During my last year of intern, I was like, "It's time to go outside of home." So I went to the capital to do my intern year, and it was crazy. It was completely different to my home city. It was bigger, chaotic. It was a big city, and I was a town girl. So it was a big contrast.

It was nice for one side, and it was so challenging for the other side. But I guess that it was my first jump to know who I am and what I want to do, and it was like, "Yeah, you are not an afraid girl, so you can go for the world that you wanted when you were thinking about business."

So, after that, I finished med school. I did my social rural service in order to get my license. So we have to give one year to the government before having your license to fully practice medicine. So technically it's seven years.

Hạ: What does that social year look like?

Nina: It's the craziest year of your life as a doctor, because you just go to a rural service, literally a town where you don't have anything. It's just you and maybe, if you are lucky, with a nurse. And you have to take care of a complete town and usually they don't have acute infrastructure. They don't have hospitals. So it's technically like a home with some beds and some medication to take care of the patients.

Hạ: In that situation, you're basically the . . . It's the equivalent, for the U.S., you're the rural family medicine doctor.

Nina: Exactly.

Hạ: Are you doing emergency care? Everything? What about surgeries? Are you doing surgery?

Nina: Oh, no. This part is out of my scope. But we need to be pretty good to recognize when a patient needs surgery because it means that you have to refer that patient to another level of service. And it's hard sometimes because you just have one ambulance. The places are four, five hours away from where maybe you are. So it means that if you send the ambulance and it becomes something urgent, you are like, "I don't have transport. What do I have to do?"

So, yeah, that's the crazy part of the rural service. You need to prioritize everything.

Hạ: So you have done clinicals for about six years, you had one year of intern year, and then now you're basically practicing medicine all alone and having to figure everything out.

Nina: Yeah.

Hạ: That's really, really scary because even with three years of pediatrics residency, I don't feel ready.

Nina: Well, I love that part of my training because it made me . . . I don't have fear by the time that I have to jump to do something. It's like, "Okay, I need to do it. I will do it."

Of course, now that you have more training, you know more the system, you have technology around you, you are like, "Oh my gosh, what was that?"

Hạ: There's something a bit funky about having someone who's fresh out of training taking care of these really underserved patients. There's something not great about that, in a way. It's just a bit unfortunate that the most underserved tends to get the least trained folks.

But it's also really cool that the government has you all do that so you can understand more about the social circumstances in the country. Do you feel like that or . . .

Nina: Sadly, it is because nobody wants to go to those places. It's the way that the government can assure that someone is taking care of them, even though sometimes it costs some doctors' lives. We call that red zone. It's where the conflict is. There are a lot of internal wars in these towns, so that's why nobody wants to go there.

And we have to go there. It's not an option that you have. It's more like, "If you want to practice medicine, you have to do that." So for that side, we don't have the opportunity to choose. It's like, "Just go."

At the same time, you feel so bad because these people need a medical team and you're like, "If I decide to say no, who will be taking care of them?" Even though it's just one year, it's a lot for them to have a family doctor there, that they know that someone will be taking care of them instead of being alone for more than one year. That sometimes happens.

Hạ: Thank you for providing that information in that context, Nina. And it really does help me reflect a lot more on the privileges of the U.S. For instance, I think our equivalent is that some providers in the U.S., if they want their medical school education funded, they're able to choose to be a part of this program where after they finish residency, they spend two to three years in a rural, underserved population.

But even when you do work like that, whether it's in rural areas, in border health, or on the reservations for the indigenous folks, there is still a level of safety to it.

Access is always a problem in these underserved areas, but it's such a drastically different perspective than the ones that people in Colombia are facing. And it really does reflect a lot about how, for me, in medicine here, people talk about sacrifice and saving lives, and there is a component of it. But now, hearing your story, I can see how outside of the privileges of America, there's so much more weight to practicing medicine than what it is here.

Nina: So that's one of the themes that I tried to figure out when I came here. When you are young, you just say, "I can do whatever I want to do." You don't have this set mind to say, "Hey, it's my life. It's my family. So what I am doing?" So I was really wild when I was younger and now I am like, "No, I need to have some safety for me and for my family." That's one of the reasons as well that I am here.

Hạ: Could you talk a little bit more about what happened? You mentioned that year of doing the work for the government's social program for medicine, and then now. What happened in between those years that led you to make this decision to make the big move?

Because I know moving to the U.S. is . . . Well, I don't personally know, but I know from my family that moving to the U.S. is a huge decision to make.

Nina: Yeah. So I fell in love with my town. I was so lucky to do my social service here with the town where my parents are from. So everybody was so special with me. It was a moment where I was like, "I really want to take care of them."

And I didn't spend just one year. I spent four years with them. That's my life, but as a general physician, I cannot do a lot for them because I'm just the person that received them and said, "You need pediatric," "You need surgery," "You need internal medicine. Just go to another hospital. I cannot take care of you." So I was like a filter.

I was like, "Is this the type of care that I want to provide in? They deserve better." So after four years, I was like, "It's time for me to decide what I want to do more about residency. What's the next step?"

I had too many kiddos in the town. I was really always enjoying taking care of them, and it was so nice to receive them, to take care of them for the first five years. And then it was like, "Oh, you are here for your well-child check, and you are 4 years old. I remember the day that I received you." So it was so amazing for me that, and I was like, "I want to work with that population."

But I had all these really sick kiddos and we didn't have a PICU/NICU close to town. I was so sad because I knew that the reason was because we didn't have enough facilities. We didn't have enough hospitals, nothing. And I was like, "Okay, that's the thing that I want to do. I want to go to get my residency, to get my specialization. And after that, I want to go back and maybe one day to have a PICU and try to resolve one part of the problem that my community is having right now."

So, by that time, I worked in three different places at the same time to get money to go to Argentina to get my residency. In Colombia, you can go to the residency, but you need to apply. So it's a moderate sum and it's less spots in medical school. For example, one hospital could have just four spots for pediatric and it's 20,000 physicians trying to get one of these spots. So it was crazy. That's for one side.

And for the second, it's not a work recognized, so you have to pay to the university to get your residency. And it's more expensive than med school. So if you don't have money, you can't study. It's like a circle where you say, "Okay, I will make some money going to this school," but at the same time, the time is coming and you are getting older and everybody wants fresh students and you're like, "I am out right now."

So I decided to go to Argentina. I did all my paperwork. I was ready for school, and I fell in love with my husband. It was crazy because we were dating for two years, and we were long distance relationship. And by the time that I told him, "I want to go to Argentina," he was like, "Yeah, you can do it." But when I was there, he was like, "You can do it. I cannot do it." And I was like, "Oh, I'm so sorry."

And he was like, "Why don't you just come to the U.S., try to learn some English, see if you like it, and maybe you can move to here?" And I was like, "Never mind. I want to be a pediatrician, so don't try to be in my way."

But I remember that it was in October, and I as supposed to start the next October. So he was like, "You have still one year, so you can come here and, I don't know, take time off. You have been overworking all the time. Just go back by the time that you have to start the school." And I was like, "Yeah, I can do that."

So I came here, and it was supposed to be for a couple of months. I finished during the COVID time, so everything was closed. And my dream to be a resident in Argentina was like, "No. Sorry." I was like, "What is happening to me? Everything that I am so close to be where I want to be is . . . something happened."

So I was here, and I was so frustrated, of course. I used to work in critical care, so being here during the peak of COVID, knowing that my parents were in a town that we didn't have a lot of physicians there, I was like, "What am I doing here? I want just to leave."

I tried, and I didn't have the chance to get into this humanitarian flight. And I was like, "What else can I do here?" And in the US, they were like, "You cannot do anything because you don't have license. So go to your home." And I was like, "No."

Hạ: Also, just so wild because thinking about all the training that you've done, the fact that you've also basically functioned as your own attending for an under-resourced town for several years, worked in critical care, and it's so hard once you get to the U.S. to be able to do things again.

For our listeners who don't know, this is actually a barrier that many international medical graduates face when they come into the U.S., which is unfortunate.

Nina: I know. But this is the short part of the history. So my university is new, 20 years old, but it's new for the world. So we didn't have the paperwork in the U.S. to be licensed here. So I have to go and do all this paperwork during COVID time. That was crazy too because everything was closed. Everybody was working from home.

So I have to send all my medical degree, all my notes, all the paperwork from the university saying that they were certified, that they were with accreditation. For me, if you ask me, it was the worst part of being here because I hate paperwork. It's like, "No way."

So it was two years trying to help the university to be recognized to be going to the U.S. system. That was the worst part of this crazy path, but we did it. So with help of the university, with help of the health ministry in Colombia, and here with my husband, he helped me with everything. So we did the worst part that was the paperwork.

And the second part was doing all the UCMLE examinations that everybody hates. It's like PTSD with the Step 1, Step 2, Step 3. And we'd have to do occupational English test. So it was four tests. And I was like, "Ugh." Every time that I had one, I was like, "No."

Hạ: Also, it's hard because I feel like you're probably not getting as long of a break between each task. I have maybe a two-year break between each of the steps. You probably were doing it back and forth like that.

Nina: I remember that I did my Step 1 on February 2022, and my Step 2 was in September 2022, and my Step 3 was in February 2023. So it was like one after the other. I guess that my brain started crashing.

Hạ: Through this whole process, were there any other different things that you found outside of the annoying paperwork . . . we all hate paperwork. And exams. We all hate exams . . . that you found was really challenging in trying to navigate this new healthcare system and this new process?

Nina: Trying to apply to residency is the milestone for IMGs because they have too many requirements. First, you need to be a fresh graduate. I was not a fresh graduate. And they are not thinking about your experience. They are thinking, "You left school five years ago. Why do you want to return to the school? So I don't feel like you are capable to do that." And you are like, "I am out of school because I have to work to get some money to try to live." And they are like, "No, you are out of school, so maybe you don't remember how to study." And you're like, "It's medicine. You are always studying, even if you don't want." That's the first thing.

The second is trying to know how the residency application works. You don't know that. I think that that's one of our problems because during med school in the U.S., you have four years to try to figure out what did you need to do that. And for us, it's six months maybe after we finish the last USMLE examination. It's like, "Okay, I can apply to residency. What do I need?"

And now that I am on this side, I can see what I was trying to look by that time, and I was wrong. It's like a dance for me. So you just go and try doing your med school, trying to get all the needs for your residency.

You know that you will need experience, that you need to show why you want to be a pediatrician on your side, that you need to work with some pediatricians closely so they can talk about your work, that you have to do a personal statement trying to sell yourself to a program. That's the way that I was seeing this process, trying to say why you are so good for that school and not why you want that school. So it is, but at the same time, you want to show that you are worthy.

And we have a different mind in Colombia and many parts of South America. We're just trying to say why it's that university, why I want to go there, what they have. It's like, "I want you. I want you." It's not, "You need me." So it was different.

So, in the personal statement, you are trying to say, "Yeah, I have all these requirements that you are asking, and you are the best. I want to go to you." But the reality is that you need to show yourself. And this is one thing that we don't see in that side.

When I look back to my personal statement, I am like, "I didn't try to sell myself." That's why many of us are like, "What happened with our personal statement?" But it's because we don't understand the system deeply. You cannot try to do something that you don't know that's in the system.

Hạ: Yeah. And it is interesting that you're saying about how we are. In U.S. medical schools, we are essentially prepared for residency since day one. I remember orientation, and they were like, "So you've made it to medical school. Congrats. Now, the match process." And we were like, "What? We just got here. Good grief."

But it is true. It's this weird dance and this weird balance of going, "You will make me a better physician, this residency program, but also I will make you a better program."

I talked with my mom a lot because when she thought I was choosing medicine, she thought I was doing kind of an easier route. In Vietnam, it's similar. You graduate from high school. You do six years of training. Not as many applications and interviews involved. And when she saw all this, she was like, "This is just so bizarre." It's just so different how we do it here compared to a lot of other places.

But with all of this, especially because you're new to the country and you're trying to find mentors and all of this, how did you end up navigating it and being able to get to this point?

Nina: Well, I think that podcasts is the reality. There are people that think that success history is the best. And I was like, "I want to listen to the other side of the history. What happens if I don't achieve it?"

So I was listening to both sides, and I tried to find the history of many people, as much that they wanted to share about how they did it to go into their dream program or residency program, and what happened with that part that didn't get into, and why, and what they did to get better.

I tried to find everything. I was joining groups from every part of the world, learning from different cultures what they did to get into the U.S. system and how they were successful.

Hạ: That is really awesome that you did all that research. I think I would have gone insane, especially because a lot of influencers and blogs, you have to sift through things to find the really good stuff. So a huge kudos to you for navigating it.

But also, part of it for me to get through this process was a lot of mentorships and being able to get people's feedback and people talking to me. And so I can't imagine kind of trying to navigate it alone. Well, not alone because you had your influencers, but in a way alone.

Nina: I don't know. I just look back and I am like, "I don't know how to do it." I guess that it was just this feeling that I really want to go into my residency. So I didn't have in my mind that I would fail. I was always like, "No. You need success. This is the thing that you really want, so what do you have to do?"

And every day, I'd read more about someone's . . . what they did, what I have to do, where I am in the process, what I need to do for being better.

Feedback was one of my ways to get that. I was always with people. They were like, "Oh, you need to improve that." And I was like, "Yeah. How can I do that?"

I was super shy. I am super shy. I was like, "If you want this, you cannot be shy, Nina. You have to go whatever you want to do it." So it was crazy at that time. It was a lot of challenge for me, especially because it was not part of my personality. But now I'm so glad that I did it.

I remember the wild teenager that was trying to do whatever she wants in order to prove her dad that he was not right. And I was now like, "I need that wild teenager to do what she needs to do to prove herself that she's capable to do what she wants to do."

Hạ: I really appreciate you sharing and being really vulnerable about this whole entire journey and of all the discovery and all of the work that you've done to get to this moment.

The theme for this season, Nina, is exploration and discovery. So in line with that, I'm now curious with all that you've done and all that you've been able to really, in a way, understand about yourself or the experiences that you've been able to have, as you take this next step starting . . . We're both interns in residency and starting this new adventure. What are you hoping to really explore more about yourself?

Nina: That's a good question. So when I came to this path, I was always thinking about me and what I want to do and how I want to fill it. And it was always medicine. But now that I'm in the system, I feel like a child in a candy store because you always think about medicine, but you don't look at the other side.

It was so nice when I was in the first day of residency and they started talking about DEI, med education, about research. And I was like, "What is that?" So I was so excited. I'm still so excited that I want to do everything. And then you're like, "Oh my gosh, what is that?"

So being in a country where . . . It's like everybody is the same, so we are all Colombians, and we know what we need. We know what are all problematic. We know what are all conflicts, and we know our history. It's like everybody knows everybody in some way.

But being here is . . . I don't know too much about people. I don't know too much about the world. So when I came here and I have this contrast with all these cultures, all people around the world, I was like, "I feel so bad that I am a physician, and I don't know too much. And if I want to be in the U.S., I need to be a citizen of the world. I need to think about people, communities, cultures."

I want to be more involved in my communities, because now my community is not just that town where I grew up. It's more like the U.S. It's more like my Latin people. It's more like my roots.

I am 30% from Africa, so I need to know more about that. That's one thing that I want to focus my career. How can I help other people like me to think about communities more than just a disease, or just a problem, or just something to do about? It's more how can I help them in a full way?

I want to continue that path, trying to be more involved in my pediatric side. Maybe now that I will be applying to another residency, having in mind from an early stage what is going on in this topic, in this field, and how I can improve it. I want something to give back to my communities. I still need to discover too many things. This is a pretty new topic for me, but that's my next main goal.

Hạ: That is very exciting. You know I always wish you luck in all of the things you do, and I'm supporting. Sometimes when I see that you wake up really early in the morning and drink coffee and read papers, I don't know if I quite support that because I support sleep. But I do support all of your goals and all of your wishes and dreams.

And so thank you. I feel like this is a good place to wrap up. But before we close out, I wanted to ask, Nina, if you have any quick final words of advice.

Nina: I think that passion is a lot, and you can go into many things if you really love them. And if you have a rock in your path, it won't define you or that you will feel like you will fail. You can walk around that rock and just go into your call, go into the thing that you want to do and try to continue pursuing.

Even if it takes longer, it's not about what you want at the end. It's more what you need to do to go into that path. So if you love the thing that you wanted, if you love the thing that you want to pursue, it will be more than enough to try to get it.

Hạ: Thank you so much for those beautiful words, Nina, and thank you overall for joining. We really loved getting to hear your story. It is absolutely exceptional because you are absolutely exceptional.

And I want to thank our dear listeners for listening today. I hope that Nina's story can give you a place to continue to reflect and think, in line with our theme about exploration and discovery, how you want to continue to explore and discover more about yourself.

As always, I encourage you to follow us on our Instagram, @bundleofhers. And also, you can always listen to us wherever you listen to your podcasts.

It has been my deep pleasure to chat with you all. And I guess now it's the awkward goodbye part, right? Right.